替罗非班使用时机对急性ST段抬高性心肌梗死患者急诊介入疗效的影响

目的探讨使用替罗非班的时机对急性ST段抬高性心肌梗死(STEMI)急诊经皮冠状动脉介入(PCI)疗效的影响。方法 104例STEMI患者随机分为提前治疗组(n=55)和术中治疗组(n=51),分别在急诊室内和造影后行PCI前静脉弹丸注射替罗非班10μg·kg~(-1),之后维持0.15μg·kg~(-1)·min~(-1)静脉泵入24h。比较2组患者术前和术后梗死相关冠状动脉血流复流情况、术后1h最高导联的ST段回落率、术后1wk左室射血分数(LVEF)及左室舒张末内径(LVDd)、30d内主要心血管事件(MACE)、出血事件和死亡率等指标。结果与术中治疗组相比,提早治疗组冠状动脉造影时无血流的比例低(TIM10级62%vs.80%),术中发生无再流率低(5%vs.20%),最高导联的ST段70%回落发生率高(53%vs.33%),术后1wk心脏超声LVEF值高、LVDd值低(均P<0.05)。2组间30d内MACE、死亡及术后出血发生率无显著差异(P>0.05)。结论 STEMI患者行急诊PCI时,早期联合使用替罗非班能改善PCI手术疗效,对早期心功能的改善有益,且并未增加出血风险。

Effects of different treatment timing of tirofiban in patients with acute ST-elevation myocardial infarction treated by primary percutaneous coronary intervention

AIM To compare the effects of different treatment timing of tirofiban in patients with acute ST-elevation myocardial infarction(STEMI) treated by primary percutaneous coronary intervention(PCI). METHODS One hundred and four consecutive STEMI patients were randomly divided into early treatment group (n = 55) and late treatment group(n = 51),and received an intravenous bolus injection of tirofiban 10μg·kg~(-1) and then maintained with continuous intravenous infusion of tirofiban 0.15μg·kg~(-1)·min~(-1) for 24 h after diagnosis in the emergency room and before PCI in the catheterization lab after coronary angiography.Coronary blood flow was assessed by coronary angiography before and after PCI.The rate of ST segment resolution was measured one hour after the operation,left ventricular ejection fraction(LVEF) and left ventricular end diastolic diameter (LVDd) within one week were measured.The major cardiovascular events(MACE),bleeding events and mortality within 30 days were observed.RESULTS Compared with the late treatment group,TIMI 0 flow(62% vs.80%) and incidence of no-reflow(5%vs.20%) decreased in the early treatment group,and incidence of complete(≥70%) ST segment resolution(53%vs.33%) increased.LVEF was(49.8±6.7)%and(47.3±5.6)%,and LVDd was(50.2±5.8) mm and(52.9±7.1) mm in the early treatment group and the late treatment group,respectively,and there was significant difference between two groups(P<0.05).There was no significant difference in MACE and bleeding events between two groups(P>0.05).CONCLUSION Early use of tirofiban in the emergency room could improve the efficiency of PCI and early cardiac function,and could not increase bleeding events.